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Tuesday, February 27, 2007

This is going to cause to uncomfortable shifting in the pews of Republicaterian sitting circles.

Sen. Don Balfour (R-Snellville) is sponsoring a bill which will require girls entering sixth grade to be immunized for the Human Pappilomavirus.

Sen. Don Balfour (R-Snellville), the sponsor of Senate Bill 155, said he believes the vaccination requirement is good public policy. The bill, which is scheduled for review today by the Senate Health and Human Services Committee, contains an exemption for parents who oppose the vaccine on religious grounds or cannot afford it.

Well, opinions are like you know what, so might as well throw mine in. If I had a daughter, I would have her butt at the doctor's office as soon as she became eligible for the vaccine. But I have a big problem with the government mandating a drug being injected into children where the condition it is intended to prevent is not easily communicable to others.

Let me rephrase that. I have a big problem with the government mandating injecting drugs into any of its citizens, period. The only time it is acceptable is in the case of highly contagious diseases, i.e. rubella, pertussis, where the intrusion is outweighed by the potential for a rapid, highly destructive health crisis.

UPDATE: For some local perspective on the Texas fruforal that started this whole mess READ HERE.

19 comments:

But I have a big problem with the government mandating a drug being injected into children where the condition it is intended to prevent is not easily communicable to others.

Actually, HPV is highly communicable to others. *sigh*... see, this is part of the reason why I wish we could remove the stigma from STIs... or at least, the "S" should be more accurately known to signify social rather than sexual.

Sexual activity is only one way HPV can be spread. And, even more importantly, many people vastly underestimate its prevalence, because so many people who have HPV never have symptoms. (Women are more likely than men to have symptoms; in men, without symptoms, there's no way to test for its presence.) According to CDC estimates about 80% of the population has come in contact with HPV at some point. Another stat I've seen - I don't think this one was from the CDC, though; I can look it up later - was that once you've had at least 4 sexual partners, your chances of having come into contact w/ HPV are almost 100%.

HPV is spread through skin-to-skin contact - which is why condoms don't offer 100% protection against it - and is highly transmissible. For example, it could be passed from from hand to hand, and then passed by the individual, from hand to genitals, in the bathroom.

Also, it can be present from birth (transmitted from mom to baby during birth). The HPV vaccine is used to prevent, yes, but there is also evidence that it can work against the virus already present in someone's system. My doctor was all excited to see that that's exactly what it did in my case. (It was kind of cute... look at the medicine geek! She was bragging to all the other doctors in the hall as I was leaving.)

Moving on...

You say: "Not all kids have sex." Well... so what? Most adults do. And even for those who don't - again, so freaking what? An ounce of prevention is worth a pound of cervix-cutting-and-lasering procedures, as they say.

But ultimately, how it's spread shouldn't matter. You said yourself in your previous comment that it "is not about sex." Then what IS it about? If 80% of the population (and probably more than that, if we're totally honest) has been exposed to HPV, and that's not a good enough reason to mandate a vaccine that can save thousands of women's lives, then what is a good enough reason?

How it is spread should matter. I want to research some more on the ways HPV can spread.

But there is a difference between an STD and an airborne virus.

It is important to me to show a compelling interest if we are going to go down the path of the government saying "trust us, let us put this drug in your body".

In the case of airborne virus or bacteria, immunization of a group of people that are required to spend hours in close contact is compelling. In the case of something where transmission requires more strenous hurdles including to some degree conscious choice, not so compelling.

Once again, I am not saying the vaccine is not valuable and we should do everything we can to encourage its acceptance. But every time the government says you have to put something in your body whether you want to or not, especially if its children, we should strenuously question the circumstances. And in my mind the threshold should be very high.

Well, the children will be adults one day - why not prevent it ahead of time? That's what it boils down to for me. I also HATE the not-so-subtle undercurrent in a lot of these conversations that people (kids? adults? anyone?) should be punished for choosing to have sex. (Leaving aside, I suppose, cases of sexual assault... but those pesky exceptions get in the way...) Not saying this is what you are doing, but your thing about "conscious choice" comes really close to it for me, and makes my skin tingle in a bad, bad way.

Government mandating injecting anything into persons make my skin tingle.

I understand that concern.

It would seem though that there has to be a balance between "government injecting things into you" and "what keeps the most people safe from a public health standpoint." I think that's something that can be discussed without devolving into the whole "OMG teh s3x!!1!1" area. Unfortunately I don't see that happening very much, but I am more than ready to be pleasantly surprised. I mean, certainly the government doing medical stuff (hooo boy, medical stuff! I sound so smart!) can be bad, bad, bad... look at eugenics in Georgia up until the 60s for fuck's sake.

I think in this case, the benefits far outweigh the concerns, in the same way as the other diseases you mentioned that we have mandatory vaccinations for. Now, a useful conversation that I don't see many people considering is one of cost and the effect on the working poor.

You can't really have this conversation about this particular vaccine without talking about the drug company's (Merck?)lobby's role in getting legislation shoved down our throats, or into our daughters' veins I should say.

Currently, there is no generic vaccine on the market, so this particular drug maker's lobby-ista are being dispatched to push the shit out of it... while they, the drug co, will still be the greatest profiteer in the whole mess. Invest now!

Currently, there is no generic vaccine on the market, so this particular drug maker's lobby-ista are being dispatched to push the shit out of it... while they, the drug co, will still be the greatest profiteer in the whole mess. Invest now!

Yep. And that's one thing I'd like to see discussed, rather than the whole freaking out over sex thing.

I'm not sure I see an opposition to government mandated immunization as correlating to a subconscious desire to see fornicators punished. What I was getting from grift’s argument (and forgive me if I’m misreading here) is that support for mandating this type of immunization is confusing, as HPV is not likely to cause an epidemic along the lines of some other communicable diseases which are also preventable, yet not required.

There are a couple other issues that concern me about this type of legislation:

1) "The bill...contains an exemption for parents who oppose the vaccine on religious grounds or cannot afford it." If there is a public policy concern behind this, why make an exceptions for two significant “at risk” populations (in my mind, the fact that religious adolescents are woefully undereducated in sex matters makes them at risk)?

2)So far, the greatest tool against the growth of cervical cancer is a regular pap smear. Even with the vaccine, a yearly pap smear is still recommended. Will vaccinations lull people into a false sense of security that unwittingly undoes all of the progress with pap smear awareness?

3)As Grayson noted, there is currently only supplier. Lack of competition + government-mandated demand = huge screw job for the consumer. I think of this every time I spend $25 bucks to get my emissions tested – a service which other states provide for free.

Ultimately, this vaccine is a great scientific achievement. But why should it be law?

Because my understanding is that most if not all vaccines administered to babies or children end up being mandated by state law as part of the process of them becoming part of the standard slate of immunizations. Vaccine law is somewhat complicated but in most states a child can't go to public school without proof of haivng the state-mandated vaccination slate.

There are also complicated issues of when a new vaccine becomes part of the standard of care for all prescribing physicians, such that failure to prescribe it or ensure that it has been administered becomes malpractice. Having a clear guideline to doctors of what they should administer to each child or each patient is important, and if there isn't such a mandate for a particular vaccine then I guarantee you the doctor will want to go ahead and give it to all possibly covered patients anyhow in order to avoid the potential liability that would come from only prescribing it for some patients, if others ended up developing the disease they could have been immunized against.

Here's a good website about vaccine law, which I do not pretend to really know much about beyond having it crop up in one of my former cases.

machine discussed this on his blog, and, as the mother of a 9-year-old girl, I have to say I whole-heartedly agree with griftdrift. My daughter is going to be vaccinated as soon as she is eligible, and I've already discussed with her the basic reasons why (she's seen the commercials, so she was asking about it). This bill was introduced in Texas, and essentially, the issue boiled down to the fact that Merck hired the Governor's best friend to lobby for the mandating the vaccine. Lo and behold, the Governor introduced the legislation. Imagine that!

Even the doctors came out on the side AGAINST mandating the vaccine because of expense, production, and not enough long-term research issues. So make no mistake, while the heart of the legislation may be in the right place, follow the money trail.

I blogged on this over at my blog (several times now, actually), too, but I don't really have any objections to the vaccine being promoted like crazy. I really feel that a huge difference could be made if most of the population were vaccinated. But it's pretty much impossible to mandate something you won't pay for, and the state's not going to pay $400/per for all the girls of age to get the vaccine.

Big pharma has always lobbied aggressively, as evidenced by price controls, protectionism and shutting down price negotiation for Medicare. Merck’s moves with Gardasil are nothing new, but hopefully it will be a watershed event for recognition - and limiting - of their influence.

Re the monopoly on production/profit of Gardasil, it is just like any other new drug. WTO intellectual property rules give the patent holder 20 years of protection until generics can be synthesized. That sucks but it is still the law. Should another pharma take up the cause and find a different route to the same vaccine then there’d be some competition, something better for all of us.

Re Gardasil and the feared church coed Fuck-a-Thon: Another TX blogger raised the question of what kind of reaction could we expect from social conservatives if an HIV vaccine is found? Will that crowd shriek and buck against that one, too, even if not mandated?

the state's not going to pay $400/per for all the girls of age to get the vaccine

Plus, it's a administered in a total of three shots over the course of six months, rather than just one shot.

I don't think that should make a damn bit of difference, and I think everyone should get the vaccine and it should be a priority. I'm just saying, it does create more difficulties for people who don't have a car, don't have flexible work hours, etc.

Anyway, again: the "all kids don't have sex" excuse doesn't hold water for me, because this isn't about protecting the KIDS - it's about protecting them when they're ADULTS. And the best, smartest way to do that is to make sure they're vaccinated (and educated!!) ahead of time!